Cystic Fibrosis in Adults discusses the advances and reviews extensively the clinical issues that are pertinent to patients with this disease. The first several chapters serve as an introduction and review the pathogenic mechanisms that may be potential targets of therapy. Along with improvements in the clinical care of patients with cystic fibrosis, our understanding of the molecular and cellular biology of the disease has expanded rapidly since the identification of the gene for cystic fibrosis 10 years ago. The physiologic and genetic information about the basic defect has provided valuable insight into the structure and function of the cystic fibrosis transmembrane conductance regulator and how mutations in the gene for this protein may contribute to the pathophysiology of the disease. This knowledge has led to a shift in the therapeutic approach to cystic fibrosis. Whereas previous therapies were directed at the downstream effects of the disease, new therapies are being designed to correct or bypass the basic defect.
Because more than 90 percent of patients with cystic fibrosis die from associated lung disease, much of the book is devoted to the pulmonary manifestations of cystic fibrosis. Several chapters discuss the current management of sinopulmonary disease in cystic fibrosis, which is directed primarily at the consequences of infection and inflammation, as well as the role of lung transplantation in end-stage disease. New approaches to treatment of pulmonary disease are also discussed, with a focus on the status of gene therapy for cystic fibrosis. Although this information may be useful to researchers, many of the details included in the discussion are probably irrelevant to clinicians. Less space is devoted to some of the newer, exciting pharmacologic therapies that may correct or circumvent the defective cystic fibrosis transmembrane conductance regulator. Many of these new drugs are now being used in patients, and I suspect that they would be of great interest to clinicians who care for adults with this disease. Indeed, these therapeutic strategies may deserve a chapter of their own.
The remainder of Cystic Fibrosis in Adults covers many of the extrapulmonary manifestations, with particular emphasis on the pancreatic and gastrointestinal complications of the disease. It also includes chapters on clinical topics that are neglected in other textbooks, such as reproductive issues in patients with cystic fibrosis.
Cystic Fibrosis in Adults clearly shows the symbiosis between research and clinical care with regard to the disease. The book is well organized, and the individual topics are covered thoroughly. Inevitably, as in any multiauthored book, there is some duplication of the information presented. Nevertheless, the editors have produced a useful reference book, and this comprehensive textbook integrates information on the care of patients with new insight into the pathogenesis of cystic fibrosis. As our understanding of the molecular and cellular basis of the disease advances, new therapeutic strategies will emerge that ideally will increase the life expectancy of patients even further. With luck, future editions will need to include a section on the geriatric care of patients with cystic fibrosis.
Reviewed by Thomas Ferkol, M.D.
Copyright © 2000 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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Cystic Fibrosis in Adults [Illustrated] (Hardcover),
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This review is from: Cystic Fibrosis in Adults (Hardcover)
This is an incredible book that can assist any adult CF patient. The authors work in North Carolina at UNC and have an excellent grasp of the problems the disease has on parients and more importantly, they understand the progression in adults.
For someone looking to understand the reasons for the tests, and what the goals are in treating adult CF patients, this is the book to get.
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